Venezuela struggles with shortage of doctors

CARACAS - Thousands of Cuban doctors and other medical personnel working in President Hugo Chávez's popular health clinics in poor neighborhoods have left Venezuela, according to Cuban doctors and Venezuelan health volunteers.

Though some 15,000 remain, the departures have forced the government to close many of the clinics, severely disrupting the Barrio Adentro program -- Inside the Barrio -- that many say helped Chávez win a recall referendum in 2004 and a resounding reelection Dec. 3.

''They began to remove them eight or 10 months ago,'' said Judith Aponte, coordinator of the volunteer neighborhood health committee in the Caracas barrio of Santa Eduwigis. ``We were lucky enough to have eight doctors. Now there are just three.''

Barrio Adentro, launched four years ago, aims to bring primary health care to the country's poorest inhabitants. More than 20,000 Cuban medical personnel -- doctors, nurses, dentists and others -- have been the backbone of the program. There are more than 8,500 such clinics nationwide,It's not clear why the Cubans left, though some Cuban doctors still here saythose who left had fulfilled their three-year assignments. Hard facts about the program are often elusive. Even the pro-Chávez government ombudsman, Germán Mundaraín, complained in a December report that it was ''very difficult to obtain up-to-date information on spending figures and health indicators'' related to the program.

''The information is managed by Cuba, not by Venezuela,'' says María Elena Rodríguez, who coordinates health research for the independent human rights group Provea, ``When we asked for cost figures last year, [the Venezuelan health ministry] said, `If you get that information, please send it to us!'''

The doctors' departure is not believed to be connected to the defections of several of the Cuban medical personnel. Nearly 50 such defectors are reported to be living in Colombia while awaiting U.S. visas.

In Santa Eduwigis, just one of the original six Barrio Adentro clinics is fully manned. In rural El Junquito, on the outskirts of the capital, eight out of 11 clinics were closed when The Miami Herald visited in December.

''It's because the Cubans have gone home,'' said Gisela Cabrera, one of 1,100 Venezuelan doctors slated to replace some of the Cubans when they finish a postgraduate course in primary health care.

Venezuela is currently dependent on the Cuban assistance, which the Chávez government originally agreed to pay for with oil exports to Havana. But in November, two opposition oil experts presented documents they said showed that Cuba had been paid a total of $340 million last year for ''goods and services'' supplied under the terms of the oil agreement. The Chávez government denied any such payments were made.

Cuban doctors working on the program, speaking on condition their names be withheld, confirmed the medical personnel had left Venezuela and said that was because three years was the maximum tour of duty abroad for the Cubans, who began arriving here in large numbers in 2003.

According to one of them, 6,800 Cubans were withdrawn in the course of last year. ''They will be replaced,'' she said, although she could not say when. ''You have to remember,'' said another, ``that Cuba needs doctors, too.''

On the island, there have been scattered reports of complaints that sending so many medical personnel to Venezuela has left many Cuban clinics understaffed.

Last year, the Cuban government said 31,000 of its doctors -- nearly half the total -- were working on humanitarian missions abroad. Cuban Vice-president Carlos Lage said last month, on a visit to Caracas, that ''26,800 doctors and other health workers'' were involved in Barrio Adentro.

Deputy Venezuelan Health Minister Carlos Alvarado, who is in charge of the program, would neither confirm nor deny that 6,800 Cuban medical personnel had in fact been withdrawn but said, ''We still have 15,000.'' He declined to clarify the number.

The decline in the Barrio Adentro clinics is so evident that both the Venezuelan Medical Federation -- which always opposed the presence of Cuban doctors -- and leading Venezuelan doctors involved with the program have spoken of their concern.

Douglas León Natera, president of the Medical Federation, recently said that 45 per cent of clinics were not fully operational. And Adolfo Delgado, who chairs a pro-government association of primary health-care specialists, said there were, ``many clinics abandoned . . . a situation which affects the population.''

Fernando Bianco, president of the doctors' association in Caracas and a longtime supporter of Barrio Adentro, told journalists last month that the program had been ''to some extent neglected,'' as the government concentrated on other elements of the health service and had ``great deficiencies.''

The shrinking number of Cuban medical personnel is not the only problem facing the program. Venezuelans involved with the program say that Cuban-supplied medicines are insufficient to meet demand.

''There are usually enough medicines for the first five days of each month,'' said Venezuelan doctor Gisela Cabrera. ''But sometimes they all go in one day, because people get word that the medicines have arrived.''

Alvarado acknowledged there were some ''flaws'' in the distribution of medicines, but claimed that ``for the most part, it functions adequately.''